Erector spinae plane block added to intercostal nerve block versus intercostal nerve block alone for postoperative analgesia in video-assisted thoracoscopic surgery: A randomized controlled trial

OBJECTIVE: The aim of the study was to investigate whether the addition of an erector spinae plane block (ESPB) to surgical intercostal nerve block (INB) provides additional postoperative analgesic benefits in patients undergoing video-assisted thoracoscopic surgery (VATS). METHODS: This prospective, randomized controlled trial included 60 adult patients undergoing elective three-port VATS. Patients were randomly assigned to receive either combined ESPB plus INB (EI) or INB alone. Patients, surgeons, ward nurses, postoperative outcome assessors, and data analysts were blinded to group assignment, whereas the anesthesiologists performing the intervention were unblinded. The primary outcome was pain intensity at 1 hour postoperatively, assessed using the Numerical Rating Scale (NRS). Prespecified secondary outcomes included repeated postoperative NRS pain assessments through 48 hours and cumulative opioid consumption at 24 hours. RESULTS: The NRS pain score at 1 hour postoperatively was 5.83 ± 2.86 in the EI group and 5.52 ± 3.10 in the INB group (mean difference 0.31, 95% confidence interval [CI], -1.25 to 1.87, p = 0.691). In a post hoc exploratory longitudinal analysis, a linear mixed-effects model demonstrated no significant group-by-time interaction in postoperative NRS pain scores (F[7, 401.2] = 0.81, p = 0.581). Cumulative opioid consumption at 24 hours, expressed as intravenous morphine equivalents, was 41.0 mg (interquartile range [IQR], 31.0-58.5) in the EI group and 40.0 mg (IQR, 29.1-48.3) in the INB group (between-group difference, 3.0 mg; 95% CI, -6.2 to 12.0; p = 0.501). CONCLUSIONS: Adding single-injection ESPB to surgical INB did not significantly reduce 1-hour postoperative pain scores or 24-hour opioid consumption following VATS. Larger adequately powered studies are required to determine whether smaller clinically relevant incremental benefits exist. TRIAL REGISTRATION: ClinicalTrials.gov NCT03949790.